Investment in statewide tobacco control programs can
reduce smoking rates, according to an evaluation of the
American Stop Smoking Intervention Study. The ASSIST study,
which was established by the National Cancer Institute in
partnership with the American Cancer Society, intended to
reduce smoking by funding the development of state tobacco
control programs to promote smoke-free environments,
increase taxes and limit youths' access to tobacco
products. The evaluation found that ASSIST states had a
greater decrease in the prevalence or number of people
smoking compared to non-ASSIST states.

The study is published in the Nov. 19 edition of the
Journal of the National Cancer Institute and is the
most comprehensive evaluation ever conducted on a large,
multistate tobacco control study.

"Our research emphasizes the importance of strong
tobacco control programs and effective policies," said
Frances A. Stillman, director of the ASSIST evaluation and
an associate research professor with the
Department of
Epidemiology and Institute for Global Tobacco Control
at the Johns Hopkins
Bloomberg School of Public Health. "States can reduce
smoking prevalence and the enormous health and economic
burden of smoking if they put in place proven programs and
policies."

ASSIST provided $128 million to fund smoking reduction
initiatives in 17 states over an eight-year period. The
states that received funding were Colorado, Indiana, Maine,
Massachusetts, Michigan, Minnesota, Missouri, New Jersey,
New Mexico, New York, North Carolina, Rhode Island, South
Carolina, Virginia, West Virginia, Washington and
Wisconsin. The money was administered in two phases,
between 1991 and 1993, and from 1993 to 1999.

For the evaluation, Stillman and her colleagues
compared changes in tobacco control policies and the effect
on per capita cigarette consumption and smoking prevalence
among adults in ASSIST states, non-ASSIST states and
Washington, D.C. They developed the Initial Outcomes Index
to access the intensity of a state's tobacco control
policies and the Strength of Tobacco Control Index to
measure the capacity and infrastructure developed to carry
out tobacco control efforts in all states.

According to the researchers, ASSIST states had a
small but significant decrease in smoking prevalence, which
would translate to about 280,000 fewer smokers nationwide
if all 50 states and the District of Columbia had
implemented ASSIST. Overall, states that made greater
improvement in their tobacco control policies had greater
decreases in cigarette consumption. States that developed
greater capacity and infrastructure to deliver tobacco
control programs also had greater decreases in cigarette
consumption.

"The National Cancer Institute spent $128 million for
the ASSIST project, which was the largest federally funded
tobacco control initiative at the time. Finding a positive
effect from ASSIST is significant considering that the
tobacco industry actively opposed ASSIST and its policy
interventions as well as spending $47 billion in product
advertising over the study period," Stillman said. In
addition, non-ASSIST states received funding for tobacco
control initiatives beginning in 1994, which made it more
difficult to measure the impact of ASSIST. "Even given
these factors, the results add to the body of research
documenting that strong policy-focused interventions can
have a significant effect on smoking behavior."